Get Presumptive Eligibility Protocol

This guide offers step-by-step instructions for completing the Presumptive Eligibility Protocol online. By following these directions, users can efficiently fill out the necessary sections of the form to ensure eligibility for Applied Behavior Analysis services through BabyNet.

Follow the steps to complete the Presumptive Eligibility Protocol accurately

1. Click ‘Get Form’ button to obtain the form and open it in your preferred editor.
2. Begin by entering the child's name and date of birth in the appropriate fields. Ensure the name is spelled correctly and the date is formatted as MM/DD/YYYY.
3. Indicate the current age of the child in months. This is critical as it determines eligibility within the defined age range of 18 to 33 months.
4. Complete the section regarding parental or team concerns about Autism Spectrum Disorders. Provide detailed descriptions of any observed behaviors or developmental concerns.
5. In the next part, select or input the name and contact details of the Early Interventionist, Primary Care Provider, or Child Care Staff administering the screening. Include relevant credentials if necessary.
6. After filling in the core demographics, proceed to fill out the Modified Checklist for Autism in Toddlers (M-CHAT) section. Be as thorough and accurate as possible in answering each question.
7. If the M-CHAT indicates a follow-up is needed, include the details of the STAT clinician selected from the approved providers list. Document the prioritized selections made by the parents.
8. Once all sections are filled out, review the entire form for accuracy. Confirm that there are no missing fields and that all information is clearly presented.
9. Finalize your entry by saving any changes made. You may also choose to download, print, or share the completed form for submission with the appropriate parties.

Take action today and complete the Presumptive Eligibility Protocol online to ensure timely eligibility for vital services.